Conditions of Boarded Out Babies of Wet-Nurses, Colonial Australia

Wet-nurses themselves rarely left written accounts. In this article, I have reconstructed their experiences and work situations breastfeeding other women’s infants in colonial Australia through examining available sources concerning their employment situations and the fate of their infants when they were boarded out, as they commonly were. The employment of wet-nurses by royal households or prominent families has long been the topic of historical accounts, whereas the situation of the more numerous wet-nurses further down the social spectrum has received disproportionately little examination. In this article, I do not discuss informal, altruistic wet nursing by family or neighbors but, rather, the situation of those women for whom it was an occupation, by its very nature short term. Primary material sighted for this study included a considerable number of advertisements for positions placed by employers, their intermediaries (e.g., family physicians) and wet-nurses themselves, and newspaper reports when the wet-nurse’s children came to the attention of the courts. Death for boarded-out infants who succumbed to inappropriate feeding and substandard care was typically ascribed to “natural causes.”

Can the Use of Health Insurance Claim Data Benefit the Risk-Based Supervision of General Practitioner Practices? An Exploratory Study in the Netherlands

Background: The Dutch Health and Youth Care Inspectorate has organized a study investigating whether there are benefits to using claim data in the risk-based supervision of general practitioner (GP) practices. Methods: We identified and selected signals of risks based on interviews with experts. Next, we selected 3 indicators that could be measured in the claim database. These were: the expected and actual costs of the GP practice; the percentage of reserve antibiotics prescribed; and the percentage of patients undergoing an emergency admission during the weekend. We corrected the scores of the GP practices based on their casemix and identified practices with the most unfavorable scores, ‘red flags,’ in 2015, or the trend between 2013-2015. Finally, we analysed the data of GP practices already identified as delivering substandard care by the Health and Youth Care Inspectorate and calculated the sensitivity and specificity of using the indicators to identify poor performing GP practices. Results: By combining the 3 indicators, we identified 1 GP practice with 3 red flags and 24 GP practices with 2 red flags. The a priori chance of identifying a GP practice that shows substandard care is 0.3%. Using the indicators, this improved to 1.0%. The sensitivity was 26.7%, the specificity was 92.8%. Conclusion: The Dutch Health and Youth Care Inspectorate might use claim data to calculate indicators on costs, the prescribing of reserve antibiotics and emergency admissions during the weekend, when setting priorities for its visits to GP practices. Visiting more GP practices by the Health and Youth Care Inspectorate, and identifying substandard care, is necessary to validate the use of these indicators.

Role of antenatal care in reducing incidence of eclampsia in eastern Uttar Pradesh, India

Background: Eclampsia is characterized by sudden onset of generalized tonic-clonic convulsions or coma in pregnancy or postpartum. It is a major cause of maternal and perinatal morbidity and mortality in developing countries. This study was conducted to determine the incidence of eclampsia and role of antenatal care in reducing the incidence.Methods: This was a prospective study (July 2015-June 2016) conducted in labour room of department of obstetrics and Gynecology, BRD Medical college, Gorakhpur, Uttar Pradesh, India. A total no. of 141 women presenting with eclampsia were included in the study. Risk factors like antenatal care and sociodemographic status were studied for their role in increased incidence of eclampsia.Results: There were 141 eclampsia cases out of 3536 deliveries, during the study period. The incidence of eclampsia was found to be 4%. Out of 141 eclampsia cases 35.5% did not receive any antenatal care. 56.7% received substandard care in less than 4 antenatal visits. Out of those who received antenatal care (91/141), 67% received irregular, substandard care in primary health centre of their locality. Majority of eclampsia cases were between 16-25 years of age (85.1%) and were primigravida (62.4%). Majority of eclampsia cases were uneducated (89.4%), of lower socioeconomic status (71.4%) and belonged to rural area (67.4%).Conclusions: High incidence of eclampsia in B.R.D. Medical College reflects the status of eclampsia in eastern Uttar Pradesh, India. To prevent eclampsia our health care centres should be strengthened by well trained medical officers, other health care workers and adequate antenatal care facilities.